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HomeMy WebLinkAbout018-2003-24-000Wisconsin Department of Commerce PRIVATE SEWAGE Sll'ST~I~I Safety and Building Division INSPECTION REPORT /~ , GENERAL INFORMATION (ATTACH TO PERMIT) ' ~ / Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. V~ l Permit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: ~o r'~ ~ 3 ~~ rt.e- -e.~.e,~a~r~J TAAILC IAIC~IDMATIf1A1 GI G\/ATI/1N1 11ATA TYPE MANUFACTURER CAPACITY Septic Dosing ,y Aeration Holding STATION E Benchmark n3 ~. Alt. BMAIt. BM Bldg. Sewer SUHt Inlet TANK SETBACK INFORMATION ~~~~'~ ~DOFz"~~.r TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~ ,r ~,~ 5 ~ ~ r ~ J ___- Dosing ~l/-P,~-~" YL© 3"- ~I.bY'f'h /u7~"!"F- Aeration Holding PUMP/SIPHON INFORMATION Number Forcemain ILeIgSD ~ IDia. a~/ IDist.to SOIL ABSORPTION SYSTEM GPM 07~, .~ TDH Ft ASS' r' Dt Inlet Dt Bottom eader/Man. Dist. Pipe Bot. System Final Grade t Cover ~ ~ /'S ~ ~ ~. County: St. Croix Sanitary Permit No: 430667 0 State Plan ID No: Parcel Tax No: 018-2003-24-000 Section/Town/Range/Map No: 18.29.17.918 I I FS IDo. ~- 7 2•(0 /Z,o 3,t; /6/.5 ~-~o lbo •3 2. v /bZ. 3.? /6/_ /oo •~ ~ ... _ J ~ ocs.1 2- I I I I , /I rrn7hg-, .n , In ~b~, 9 - ~• 3 BED/TRENCH Width Length No. Of Trenches PIT DIMEN S No. Of Pits Inside D' iqud D DIMENSIONS ] ~ J I QD ~ _I ~ ~ ~ / ( SETBACK M TO SYSTE P/L BLDG WELL LAI~ELSTREAM LEACHING INFORMATION Type Of System: ~, Q„~ ~ ~ ~ ~ ~~ ~ / ~~~ / IT el N DISTRIBUTION SYSTEM 7~A- ~.~rK~SLPok~ ~ SaLt¢'L. Header/Manifol ~ Distribution 1 j r~ f x Hole Size ~ x Hole Spacing Vent to Air Intake ~/yl. ,, Pipe(s) /Ji~ ~ ~ 'S~3 ? l ~tJ Length Dia Length Dia Spacing 0 . SOIL COVER x Pressure Systems Only YY Mound Or At-Grade Systems Only L~~ -~ Depth Over Depth Over xx Depth of ~ xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ~ No Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~~C~ / 6`l C~~- Inspection #2: ~ /~ /G~, L, Location: 1593 97th Avenue Hammonrd, WI 54015 (NW 1/4 N~E, .1/4 18 T29N R17W) Crick Bottom Overlpook Lot 24 Parcel No: 18.29.17.918 1.) Alt BM Description = ~~ D~) CL ~ ~ ~"`~"'~' CN~ t~~c~~ ~/Q ~j B 2.) Bldg sewer length = ( lQ t~ , `'N - . 5) ~1~~ ~:/D ~ /, ~~ -amount of cover = ~ ~`~ q~Q~ ~~~ r ~1 (~,~, - ~~G~ ~ n~ rn~~ .- (~/J.~~ d~~ Plan revision Required. ~ Yes No Ct~t 1 - Use other side for additional informs ' n. ~:; ~y ~ _~ ~-' C7~W~ ~~ ~~~~ _ _ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division CO°°~`~'~ ~ ~ 1 Washington Ave., P.O. BoX 7082 201 W // . nsin wadi ~ ~ EovE "'z o i Sani ry Permit Number to be filled in by Co.) 30 6( 1~5 g l sc Department of Commerce State P 1_D. Number Sanitary Permit Applicatio ~~~~AA~~ 2 2. 200 `~S~ -T~+S• ~~~ ou proJiO~'' i f on ormat in accord with Comm 83.21, Wis. Adm. Code, personal in et:ottdary Ptttposes Privacy law, s15.04(l m) d f b Proje ddreu (if different than mailing adQras) ~, -/,j or s e use may ST. CROIX COU ONING ` N ~ ' ~ ~ ^-~ ._- n `~ ~t! Z I. Application Information -Please Print Alt Information Property O me arcel # ~ Loc tl Block 8 - C7/ ---- `d ~~ ~ ~ Property Owy~:i Mailing Address ' 1~~ Prope a on y Section / V %. V ~ I ., , City, State Zip Code Phone Number S~ ` ~ I ucl ) /~ ~ ~ J ~ E W N; R T ~ ~ stn.. II. ype of Building (check all that apply) oo ` J S // ) u ~'tA /b/division Name t..SM N Su r/ ~ (~ ~r~~-e- 2FamilyD+velling-Number ofBedrootns / ~ ( ~ ~, ~ • G'~, ,~~(/(// "„~ V {.. ^ publidCoenmercial -Describe Use ~ r Njt ^Cityr^Yillage~awnship of ~ X ^ State Owaod - Descn'be Use !' III Type of Permit: (Cheek only one boz on Line A. Complete line B if applicable) '+• System ^ Rcplaament System ^ Treautlesit/Holdiag Teak Replacement Only ^ Other Modification to Existing System List Previous Permit Number and Date Issued B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Befate Expiation Plumber Owner IY. T e of POV1'i'S S stem: Check all that a i ^ Non -Pressurized In-Ground ^ Mound > 24 in. of storable soil ^ Mound < 24 in. of suitable s ~ At-Grad ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Trratrnent Unit ^ Recirculating Sand Filter ^ I.eachia Chamber Dri Line ^ v 1-less Pipe ther (ex lain Ros;irculatiag Synthetic Media Filter g P V. Dis ersalll'reatment Area Information: Drs ersal Area Required (sf) Disyprsal Area Proposed (sf) Ystem Elevation ~ (~ /~~~) ~//7~7J , Design Flow (gpd) Design SoU Application Rate(gpdsf) l C J1 Capacity Total Number Manttfaetttrer VI. Tank Info Prefab Site Steel Fiber Plastic Concrt:u Constructed Glass Gallons Gallons of Units New Exising Tanks Tanks Septic err Holding Talc Aerobic TraatmeN Unit nosing Chamber Cowes VII. ResponSlbility State t- I, the undo ed, assume respaasibility for ins 'on of the PO S N S shawa oa the attaebed plans. mess Phone Number u Pl 's Name (Print) Plu a re MP/MPR ~ ~ J r ~~ ~ Plumber's Ad ss (Street, City, S i Code) ~ / J L VIII. Coua /D artmeat Use Onl Saatiary Permtt Fa (in odes Groundwater Date Issued Issuing t S grta a Stamps) Approved ^ Disapproved Stuchazge Fce) ~~~ ~. Q Owner Given Reason for Denial IX. Conditions of ApprovaUReasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must alt be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances Attuh complete pytas (to the County only) for the system o¢ paper not Ins than ft/2:11 Inches la sire SBD-b398 (R. 08102) PLOT PLAN ~;''I' P.C. Colbva Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 1/4 NE i/4S 18 /T 29 N/R 17 w TOWN Hammond COUNTY ST.CROIX vIPRS Shaun Bird 226900 DATE 1 /8/04 BEDROOM 3 :ONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK vIOUND SEPTIC TANK SIZE 1000 gallons LIFE TANK SIZE DOSE TANK SIZE iOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A-100 BOREHOLE O WELL sH.R.P. Same as Benchmark ELEVATION 100.5' sGa ~- = T ~~ = .~ ~o Tank is to be properly bedded and provided with lockdown covers with approved warning labels 400' Property Line Pro 3 Bedroom 100' Well is to meet all setbacks found in Comm. 83 100.5' 10 Grading is to be done to divert run-off away from system Huffcutt Combo tan 2% Slope 395' Property Line Area 15' below system is to remain undisturbed B-3 O~~ G B-1~ ~~ ~ .. ~ Alt. B.M. Top of 2 Pipe @ 100.0 B-4 ~ B, Property Lin 1 02' s ~ iscons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary January 16, 2004 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/16/2006 SITE: PC Collova Builders 1593 97TH Ave Town of Hammond St Croix County NW1/4, NE1/4, S18, Lot: 24, Subdivision: T29N, R17W Crick Bottom Overlook ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 959438 Site ID No. 670031 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Three Bedroom At-Grade System Object Type: POWTS Component Manual Regulated Object ID No.: 938922 Maintenance required; 450 GPD Flow rate; 46 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, SBD-10570-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (8.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes.. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Con. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, ~~ stats. The following conditions shall be met during construction or installation and prior to occupancy or use: ~D ARTME N OF General Approval Requirements: SEE CSR • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At- grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570-P (R.6/99) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SHAUN R BIRD Page 2 1/16/04 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on-site during_construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@c ommerce. state. wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 . ~ c~~~~~ ~~ ,~~ Cover Page ,PN 13 Z~ p~V. S~pGS pF~ & S Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 01 /08/04 Owner: P.C. Collova Bldrs. Location:NW1/4NE1/4 S18 T29 N,R17W Lot 24 Crick BottomOverlook Hammond System type: At-Grade Manuals Used: At-Grade Component Manual version 1.0 SBD 10570-P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST- SAS (01 /81) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout ~rjndly 5. Pump Chamber Cross Section D ~F COMMERCE 6. Pump Curve ~ 1LDlNG 7-9. Maintance and Contigency plan 3PpNDEN 10-12 Soil test Shaun Biri Signature License ni + PLOT PLAN PROJECT P.C: Colbva Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NW i/4 NE i/4S 18 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 1 /8/04 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL '"H.R.P. Same as Benchmark TEM ELEVATION 100.5' `" ~~ Tank is to be properly bedded and provided with lockdown covers with approved warning labels Well is to meet all setbacks found in Comm. 83 i 00.5' 1 Q Grading is to be done to divert run-off away from system 395' Property Line Huffcutt Combo tank Area 15' below system is to remain undisturbed B-4 ^ B. Property Lin B-1 B.M. Alt. B.M. Top of 2" Pipe @ 100.0 400' Property Line 1 02' ~ ~r B ~~ PVC ~O~,MR1N ..~ +, -.-- --- ~~ ~- O~srRt~.}-~Tscwt LAt~fiAt "'~ ~ A # srw~e~t z£D a~~,~~cwrsa~s WEt-L ~ 5' !f6 B,j ~ I/6B A =/ ~~~ a = U ~t. v~l = ! Ft . l4PPR[»fED SYt~tT~iETIL FQbri~ ST~~t~i~~~ Qbservdtion-----~, VYe l l ~ . > 5~ A . ~ to S~.©P~ _______ ~vz~ _,~ ,y ~ H GE L ~ o ~ !L ' Z ~ ACaGR ECs ArTE Qistribu#ion Laieral 2 X11 ~,~..~ ~r ~ -r, 6« ~._~ j ~2 Soil Cover .~ ~t.ewtED LAYF~ ?5` Plano Vicv and Cross Section of [discar+sin AC-grade Unit atith a Single Absorgtiflri Area an a Sloping Site LtC£~ISE. ~~ - S~~,NaYu~tF.: ' Page Of t}istribution Pipe fletail for lateral lfetwor4c * last Hole Shtwid $e Next To TLLR-tJ•UP ~. ~~TuRN -uP~~ ~GL@RROUT~ --, P1iC force Hain ' ;'"'i'~~ PYC flistribotion Pipe A~ re s~' ~a~ nc~ s L P 7~ p fit. Hole Oia~neter ~` Inch __._.__.__ Lateral Diameter ~ Inch(es) X Inches Y ~ ~ Incises force Main Diameter Z~_ It~ohes ~ Of Hot es~Pipe Invert ~ievation Qf Laterals ~~-~ ft. Signed: lfcense number: Date: ` CT. AAt~ SF€Cir FCATIOlvS CROSS 5£ ON ~ SFFTZC TALK ~ F~3MP CtiAMB£R _ __--- ~s~yE GRADE ~ ~£AmER~R00P ~u~iCTZON $Dx AgFROV£D COyElt ~,~+ C; „ M~~. uENT PIPE i2 0~ OR WIND , ;,tITH CONDLIiT MAivNQLE W/ PPyDL,OCK s ~ ZS• FRESH I'it0li D4fl~A. aIR ;3+t?hKE ~ y1pRKI~iG LAH£:. ~.~..4" ~IIN • E f IiiISHEfl G~ _ r, K. ~. ~=~R. ~~ Z. ~. u ~ :• ~ Z~ M1M• ;~„ ~~ • r + ~ ~ ~ ' INLET " ~ ` GAS- ~ , D i~iAT£R TZ6HT S~LS '~ TIGHT , _ sFAL • .1DIfiTS WITH "_ A LM liPPit4~-ED PIPE ~3L.T~R ~"_ ~^ ~ ' , N $ --~'-- - s StR.I SOIL ApPt~fW£D PIPE 3 ,,~ s pFF LEV • = sz = SOIL -- - Pt31~fP £}FF E O ~- BEDDZi~IG Vi~IAER TANK y~~' 1~tCRET£ P~ 3 a ppgRO~ED ~.-1.5`-~~G!.fek r~;F2CA'i'ZONS SEPTIC ! DOSE TA33K PtA1~1UFACTUIIER: TANK SIZES: SEPTI DpSE S Pte-- NLIt~iBER dOSES PER SAY = y fls„CJ1'SE I1+ZCi.(i11SNG ~, ~ GAL- ~'3aSE F LtW~AC K = C GAL . C~AL~ ~~y.S~;IyCFiES =~,~ ~AL- _ C ~ CAPACZTIFS = }'' ------ ~ ~L. A'LARtt i''1A~FAC1f3AER ----- 140DEL ~~`YFE ~ZTCH e A~, 8 ~._.r.. A ~ ~"~ _ l _ ,S-3NCHES = l,~?_~ GE'L' ~- FACTURER= z. D Pt)!ZP ~~ HSER : - 16.23 WAC HSte1Z3'C~TYt'E' S ALARri idIRI ~itG AS PER I LHR {,Pl4/L'-a p~t3P FEET nasCKARG~ RATS ~~ ~~~~iors ?sP£-~-~~ AEQvIRF~ PUMP OFF f-NI3 I}ISTg - ` ~'~ ~ VER'!"iCAL DZFFER~NCE $ET'u£EN SUR£ - '£RICTId2~ FIa,CTQR FEET] + MZNIHt3i~4 N£T'~ORK SUPPLY PRESS PT/1i~0•F~fln,~-L DYR~IC HEAD ~/ ' + ~ f EET FURCEl~ZH ~ ~ .-' DIAMET~ r ~~ ~~H~ ~uMF '£ANK: LENS ~ ~-~_ INTEg~L DiMENSIOi~S t}~ i.It~ LjC£I~SF- ~M~~:~ SIGNED= _ 4A'~~= :ts8 cn u i :` C O i i,A~ S i ~ .z. L C fi~rC~ 1E~ ~-` G ~lJ ' ~ni rjYiFd9~; HcAO;'~.APAC'Tl ' ,0:~- RER •dtvUfE EFFFUE~;T F',r.;~, JEtiv:~i E ~ItiG I i ! I reGDE~ ; ^ ! J^ ! ii -: tJJ -- --'- '' Groff ~ tg r5 ' ,. ~: ~ i _--- ~~ t i L ``~ •I 6 1 ~ I n I I -7 i 6 i 1 G9 i Q2 ~ '+-J-^~i - i ^ ~r ~"--i 1 n 7 ~ ~ - - ~ - - ~ -= ~:i ~i ~i~ i i l.L ~ -.~_.-_-__ i ( s'-~ 0 33 i_ .i iy44.G Yt. it~.6; (7.i i. ..,ci d~i~~e: .. .. i - ---~- :5~ ~: r LO~1 PI_R MItiUTt CONSULT FACTORY FOR SPECIAL APPLICATIONS .'limed dcsing panels available. ' ~ ~ lied with • Electrica; alternators, for duplex systems, are available and supp an alarm. . '~Jariable level control switches are available for controlling single p ase systems. • Couble piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°i.-) special quotation required. 1577 ~~ seneS d CAllT10N a ualified All installation of controls, protection devices and wiring should be done by q licensed electrician All electrical and safety codes shculd be toliowed including the most recent National Electric wde (NECJ and the Occupational Safety and Health Act (OSHA). _7 ~- I i. ,~/a I i T S7C2~s SEL_CTION GUIDE 1 Sinyle Piggyback variable !evei f?;;at switch or double Piggybackvanat;ieIevel float switch. Refer to FP,40?77. 2. See FPv1U712 for correcr model c' EiecUica! A!temoter E-Pak. 3. Variable level control switCtt 10~:•?~7 used as a control activator, specify duplex (3) or (4) float synem. RESERVE PO'WERED~DE th2GN ign of every Zoeller ~~~lP. For unusual conditions a reserve safety factor Is erglne ~4AJL 70: P.O. 20X ?F~7 p,{aniracfurersoi. - --"""~ Louisville, h'f S025ri-0341 ` -~~~1 ~T. SHIP T0: 354y Cane Run Rcad /.4~~" £ .~ Louisville. K'! 402??-?96i ~./dL/TY~L//i/P9 ~n'cE Z.f7 ` ii Y (50Z) 77&2Ts] • 7 (800) 928-PUMP .. -`~` 1f!/~! 1~ FFJ;15G2} 77;-3024 ~~~: zoeller-com I"U Ilwww. ___, ,~, !`~nvrinht 7000 ZOEIIC( LG. Ail tights reserved t7 ' PoVYi'S OWi+1ER'S MANUAL 8~ MANAGEMENT PLAN l ~ - __......rrIGIC_OTrOI~r.S FILE 1NFORAMTtON.------ Owner ~ ~, Permit #. DESIGN PAt~-N-C'~--- Number of~ed____- Number of Commerdat Units Estimated flow (av__e=_ pesign flaw (peak). (Estimated x '1. S) Soil Apprication Rate lnfluentlEthtlent Quality Fats, Oi! & Grease (FOG) Biochemical Oxygen Demand (BODS) Total Suspended Solids (fSS) Pretreated Effluent Quality ~ t~lA B'iochemigl Oxygen Demand (SODS) Total Suspended Solids (TSS) Fecal Coliform (geometric mean) Maximum Effluent Particle Size MAINTENANCE SCHEDULE Service Event Inspect condition of tank(s) Pump out contents of tank(s) Inspect dtspersa'I cell(s) Clean 8fttuent filter _,_ ------ lnsped pump. Pump controls 8. alarm Flush laterals and pressure test >~U D NA Monthly average! S30 mg/L 5220 mg/L 5150 mg/L Monthly average" Sao mg/L 530 mg/L 510` cfu/400m1 Y inch diameter Page of Service Frequency ^ months ear(s) (Maximum 3 yrs•) At least once every ~ y of tank volume When combined sludge and scum equals one-third (,) • imum 3 yrs.) At (east once every At (east once every At least once every At least once every At least once every At least once every (Max ^ NA ^N ^^ nmo the ^ year(s) ^ NA ^ months ^ Year(s) ^ NA licenses or MAINTENANCE INSTRUCTIONS n one of the following Inspections of tanks and dispersal cells shalt be made by an individual carryi 9 dor- POWTS Maintainer, Septage certifications: Master Plumber: Master Plumber Restricted Sewei; POWTS tnsl~ to identify any missing or broken for an back up Servicing Operator. Tank inspections must inUude a visual inspection of the tanks to check ~e effluent levels identity any d~acks or leaks, measure theisolu~l cell(s) shaleldbelvisua ly respected d to ~~ effluent on the handware. round surface. The d ~ The ponding or ponding of effluent on the g nding of effluent en tf~e ground surface. autho~Y in the observation Pipes and to check for any po red surface may indicate a failing condition and requires the immediate notification o mo ocef thg tank plume, th NR grou When the combined accumulation of sludge and scum in any tank equals one-third ved b a Septage ServiGng Operator and disposed of in accordance ~~ ~ entire contents of the tank shall be remo Y - vents, and any 113, Wisconsin Administrative Code. onents, pretreatfinent compo rformed by a certified POVI~TS Maintainer. The senaang of effluent filtersnmachn erv~ats of 12 mo the ooess sta tie pz lion of any seance event. other maintenance or moniton g of compie rovided to the local regulatory authority within 10 days A servir~e report shalt be p or other ~ for the presence of painting products STARTUP AND OPERATION If hi h concentrations are For new construction, prior to use of the POV11T ss and/otrd mage the dispersal c;e[l(s}. 9 e the treatment pmt S y a septage servicing operator pnor to use. chemicals that may impact Ssd detected have the contents of the tank(s) ^ months ^ months a-z ^ months ~ ^ months • Values typical for domestic (non-commerdat) vrastev~ramr ens septic tank effluent n Values typical (or pretreated vrastewater. .,~i'`> / Page of /Y, System startup shalt not occur when soft' conditions are frozen at the infiltrative surface. rs ~~~ ~ ~~ During power outages pump tanks may fiQ above normal highwater levels. When power . v+rastewater will ~ d~aig~ ~ the d-~pen;at cell(s) in one large dose, overloading the Dell(s) and may result in the ' bagnrp or surface discharge of effl}~ent. To avoid this situation have the contents of the pump tank removed by a Septa9e9 Ope~tior pr~r.to"restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manualy operating the pump controls to restore normal levels within the pump tank Do not drive or park vehicles over tanks and dispersal ~~' D° not drive or park over, or otherwise disturb or compact, the area wlttttn 15 feet dawn slope of arty mound of at-grade soil absorption area. Reduction or•eCunination of the following fiom the wastewater stream may improve the performance and prolong the fife: of the POWCS: t3rtffbio6cs; •babYY ~P~~ cicJarette butts; condoms; Dolton swabs; degreasers; dental floss: drapers; disinfedartts; fat; fouridaffon drain {sump Pump) water, fruR and vegetable peeCrngs; gasoline; grease;. herbiades; meat scraps; medtcatiorts; ori; Painting pnaduds; pesticides; sanitary napkins; tampons; 'and water softener brine. ABANDONi11MF.NT y4lhen the POVV7'S faits and/or is pem~aneMly.taken out of service the following steps shalt tae taken to Insure that the system is properly anti safety abandoned in compliance with ch. Comm 83.33, Vysconsjn Adm~rnl~ five Code: • -All plptng to tanks and pits shad be disc_onneded and the abandoned pipe open ng The oortbents of alt tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, alt tanks and pits shalt be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement~area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by requtr~ed setbacks from existing and proposed structure, tot fines and wells. Failure to prated the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or soil (imitations. Barrtng advances in POYYTS technology a holding tank may be installed as a last resort to replace the failed POV1~S. The stte has not been evaluated to identify a suitable replacement area Upon failure of the POVYTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed P0111rTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative suriaoe. Reconstnrottons of such systems must comply with the rules in effect at that time. <cVf(ARNING» SEPTIC, PUMP AND OTHER TRF~ITMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS Pr1WrS iNST411ER POVYTS MAINTAINER Name Gc„w ~j~j ; Phone ~j,.j .,.r ~ ~,..~ ~ J'-" Name ~ ct~.(iw~- J~," _ / Phone ~ / ZY ~~ ~,r~ SEPTAGE SERVICING OPERATO PUMPER LOCAL REGULATORYAiJTHORCIY Name ~c~~- A9eniY '' c'3! ~`' -~'' Phone ~~-- ~~ ~ ~~ Phone ~~J =-- ~~ --- rt,is document was dtaRed af! Cte sraRa of life Grnerr tarca, Marquette and Waushara County Zoning and Sanitation egCltdeS. This document meets tr,e minimum n9qurrements of cfL Comm 83.22{2)rb)(1)(dM(t) Arid 83.54(1). (2) ~ (3), wrsconsin Admfntstrative Code. Use of this document does not guarantee the performance of the POWr'S. GnRV+r (iii ~~ . w~oonsn Departrnent of Commerce SOIL EVALUATION REPORT Page ~ nivlaim of Safety and Buildings _ in accordance wdh c:omm t~sO°e ~ V E ' -F ~ C 1 ~''~ ~ size. P19p~ri+us~ Attach complete site plan ~ paper not less than 81/2 x 11 inches inducts, but not limited to: vertical and horizontal reference point (B ), direction and north arr~v, and location and d tance to nearest road. scale or dimensions e ercent slo Parcel .D. , p , p Please print all Information. Personal intorrnation you ~mride may tie used for secorrdary purposes ( ~ MAY 0 ~ 20 5.04 1) (m)). 3~^ ~ ~ ZZ O / ~ ~ ~ ~' ~ 1,'4 S ~ T N R E (or W Property Owner' Mailing Address ~ (~y ~ State Zp Code Phone Number L!I> ( ) Lot # Block # .Name or CSM# ~T G . City ^ Village Town Nearest Road New Coristrudion Use: / Number of bedrooms Cade derived design flow rate ~ Q GPD ^ Replacement ~ ~ ~ 'ai -Describe: Parentmaterial ~ ' -- Flood Play elevation if applicable I`~ 1 ~- ft- ~tions: ~~ ~f~~ e f~ ~~z~~ ~~/. ~ ~o~ jj"'" Pit Grotmd surface elev. ~ 1 ft. Depflt to rr~tirt9 factor ~ Rate Fforizon Depth Dominant Redox Description Texture Structure Consistence BourMary Roots PD/fF 'E1f#2 1 imseN Qu. Sz Cord. Color Gr. Sz Sh. 'Efi/ M in. .~ /1j / ~/ r Y ~ a / ' V ~ ~ /1" s ~ ~-~'~~ ~--- G/ ~ s.bk ~ `3 ~ ^ / J - a ~ 1 ,-3 3 r ~---- ~ .,~~ - -s - ' ~ ~.~- ~; f # U Pit Ground surface ei~y~ eft. Depth to limiting factor ~ R~ tion i D d Texture Structure Cor~sist~ce Bound~y Roots GP D/tr= Horiaor- Oeptit m, Domurant Mures escr p ox Re Qu. Sz. Cortt. Cobr Gr. Sz. Sh. •t~f#1 'EtflF2 1 0-~ ~ ~n ~ -- s ~ ~ ~ ,~ ~ r ~ , 2 I ~--a 5 ~- cr L m iL w ~ i ~ '~/ - S~_ m~ a ~' r~ r Q- v ~ Ltmcs~`onc 12 ~ ~ - _` -- Effluent #1= BOD > 30 < 710 mglt. and TSS >30 < r~cr ~ (Please l~ n ` Effluent #2 = BOD ~ 30 mglL and TSS <_ 30 rrgA. CST Number Address /~ --- --__--- lda ?3 /Q~i~,,,e~ /V (°1-/JlLii1~ ~' r- /..Jj ~ y~! Lea '~ .~ ~/~'- a ~~' ~~l . ;, I~t ay Parcel lD # Page of ® ~~ # ~ PiB t~~ Ground surface elev. l t/ ~ i ,~ ft. Depth to Grt~g fadar ~ ~ SoA Raae tiortzon Depth Dominant Redox Description Textwe Structure Consistence Boundary Roots GPDJff in. MunseR Qu. Sz Cor>t. Color Gr. Sz Sh. `Etflfl 'Eff#2 ©-,6 10 ,, 3/. -~- S ~ of rYt M~ ~ rn l ~ , Z ~_ o~ ,~- - F Z ~ 3 ~` D J`tn r ~ -" - ~. ~9 ~ ^ ~~ ^ Pit Ground surface dev. R Oepth to Pdctor in. Soi ration R2te Fioriaon Depth Dominant Redorr Description Texture Structrre Catuiatence Boundary Rants GPOVfrt in. Munse~ Qu. Sz. Cunt Cobr Cu Sz Sh. -- •Eft#1 'Efftt2 ~~ # ^ ^ Pit Ground surface elev. ft. Depth b 9 tailor in. Sad Rabe Mortaon Depth Dorrrnartt Redox Description. Texture Stnx~ure Coc>S~Gerrce Boundary Rods GPDflt= itt. MurrseR tlu. Sz Corrt. Color Gr. Sz Sh. _ `~~ ~iFti2 ` Etthterrt #t = 8t?D, > 30 < 220 mg!!. and TSS >30 < 150 mg1L ' EfRuerd ill = BODs <_ 30 mglL and TSS <_ 30 mgll. 'fhe Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. s~wts.twoot • .: ~ . Project Name Soil Test Plot Plan P.C. Collova Bldrs. Inc. Shaun Address P.O. Box 487 U Somerset Wi 54025 C ~ #226900 Lot 24 Subdivision Crick Bolton Date 2/4/02 1 /4 NE 1 /4S 18 T 29 N/R1 ~ W T h• Hammond Boring Q Well PL Property Line BM or VRP Assume Elevation 100 ft. ~~ ~ ~ y - owns ip County ST. CROIX Top of Survey Iron System Elevation 101.1' *HRPSame as Benchmark Alt RM Tnn ref 7" P7r,P (nl 1(1(1 (1' lit ay Property Owner Parcel ID # Page of ^ Boring 3 ~s # ~ Pit Ground surface elev. v ~ ' ft. Oepth to limiting factor in. ~ Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Mansell Qu. Sz Cont Color Gr, Sz Sh. ~Eff#1 ~Eff#2 "~ - ~ , . y/ ~' ~~ ~~ ice. ~ G -J y - ~. ~. ~~ Boring i 9 Bonin # ~ Pit Ground surface elev. ~ J R Depth to limiting factor ~• ~ qp ication Rate Horizon Depth Dominant Co Redax Description Texture Structure Consistence Boundary Roots GPD/ff in. Mansell Qu. Sz Cont Color Gr. Sz Sh. ~EiF#1 ~Elf#2 Z s 3a , ~ -----, ~.~/ ~ ~_ ^ Boring # ^ Baring ^ Pit Ground surface elev. ft. Depth to limiting factor ~. ~~ AnolicaGon Rate Harmon Oepth Dominant Col Redox Description. Texture Structure Consistence Boundary Roots GPOJ(f in. Mansell Qu. Sz Cont. Color Gr. Sz Sh. ~~ ~R#2 Elfluerrt #1 = BOD, > 30 < 220 rtxl/L and TSS >30 < 150 mglL ' ERtuent #2 = BODs < 30 nxyt. and TSS _< 30 rrgR The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-2fi4-8777. sr~wcN.doo- w .. V Soil Test Plot Pla Project Name P.C. Collova Bldrs. Inc. S Address P.O. Boc 489 Somerset Wi 54025 STM #226900 Lot 24 Subdivision Crick Bottom Date 1 /8/04 N W 1 /4 IVE 1 /4S 18 T 29 N/R1 ~ W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey Iron System Elevation 100.5' *HRpSame as Benchmark Alt. BM Top of 2" Pipe @ 100.0' Scale is 1" = 40' unless otherwise noted 400' Property Line 10 395' Property Line B-4 ^ B. Property Line 1 0 2' Alt. B.M. Top of 2" Pipe @ 100.0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer P• C. Collova Builders, Inc. Mailing Address P ~ Box 489 Somerset, WI 54025 Property Address (Verification required from Planning Department for new City/State Hammond, WI parcel Identification Number LEGAL DESCRIPTION Property Locatio~n %,, ~/., Sec. 18 . T 29 N-R 17 W, Town of Hammond Subdivision ~ 1` g~tom Overlook a Lot # ~. Certified Survey Map # Volume ~, Page # Warranty Deed # ~~ ~' ~ ~ a Volume ~ cls'`~ ,page # Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic systcm could result in its prcmaturafailure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can aft'ect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner. and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the on-site wastewaterdisposalcystem is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commence and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 o th a eaz expiration date. P. C. COLLOVA BUILDERS, INC. I l6 i0y SIGN OF APPLICANT (7P O. Box 4892 SOMERSET, WISCONSIN 54025 DATE OWNER CERTIFICATION I (we) ce 'fy that all statements oa this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the d ed above, by virtue of a warranty deed recorded in Register of Deeds Office. ~'. C. COLLOVA BUILDERS, INC. ~ ~ / ~ SIGNA OF APPLICANT (715) 247-2742 P.O. Box 489 DATE SOMERSET, WISCONSIN 54025 **«*** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. **«««« r ~~ ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed U 1950P 5281 ~.--- STATE 8AR C)F W {SCONSIN FARM 1-1998 WARRANTY DEED This Deed, made between Jonn J anon ang carolvn u. vatton. hus nd and wife . Granttx, and P. C. Cdtgva Binders. {nc. .Grantee. Grantor, for a valuable consideration corneys to Grantee the tdlowing described real estate In St. Croix County State of Wisconsin (the "Property'): Ream Aodroes P CoYotra Butldera, Inc. x Avenue ~m~o~~jd/~, WI/,5,/14~0f13 9(,/J/~/ ~/~~V/// W~~/ Jv 9 O18-1039-20-•000 / 018-1039-10 OC 018 1039 80 000 Parcel tdentl3catlon Number (PIN) Thla Is not homestead property. (Is) (IS not) See Exhibit A attached hereto Together with all appurtenant rights, tlUe and Interests. none Grantor warrants that the title to the Properties good. indefeasible in simple fee and free and clear of encumbrances except Dated this 15th day of August. 2002. (gam) (SEAL) • hn J. Iton arolyn G.~Oalton (SEAL) (SEAL) A~t0~~1C -. f-~~E OF WtS S19natut~e(s) -~P~t,v c~„ ~ ZINC - atrthenticated tats NO 31.1Ci ~A~N~-' TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §lOt3.08, Wis. Stets) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker eumet 1301 Coulee Road Hudson, W 154016 22470 (Signatures may be authenticated or acknowledged. Both are not necessary.) • Nsxnea of oeraens sfenina In env caoeciN murt be typed or 1 ACKNOWLEDGMENT ~~ ' 667242 KATHLEEii H. MALSH REGISTER OF DEEDS ST. CROIX CO., YI REC6IY8D FOR RECORD '' ~ w_ `2~~, ~ f~~ 08-16-2082 9:00 AM HEED OV E ~~b oK REC FEE: 13.08 TRAAS FEE: 1155.08 ~ O F COPY FEE: CERT COPY FEE: PAGES: 2 Area Stets of Wlsconetn, } ss. St. Croix County Petaonally came before me this 1~ day of AuausL f~2 the above mad a I It ban nd W if 1..,~ ~~-~ ~• Notary Public. State of Wisconsin My cammbaton b pe anent. (If not, state expiratbn date: ~~5 ~~ , below STATE BAR OF VISCONSIN Wlaconsln Legal Bienk Co, Inc. WARRANTY DEEP FORM No. i -1898 MUwaukee, Wis. ;a.` ;, • -~•.,~~ ,. .., ". -w.:rw.ur:.r:+~l:r7::•:L:w•:~:a'ir,L.~iyNI~ICWIjr,~ :. ~ .. ~, `~ '~'add'Yv'Ibdrri~~°r'Y~dl~..+-:eCfi9k,.•.~drr,s . A part of the NE'/. of the NE +/, and In part of the NW y. of the NE '~ and in part of the SV4' Y of the NE Y. of Section 18, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin and more partkylarty described as: Begi~ng ~ the Northeast comer of said Section 18; thence S89.33'31'W 372:01 feet along the North line of the NE '/. of said Sectlan 18; thence S89'33'31"{N along the North iine of the NE '/. of said Sectlvn 18 715.94 feet; thence S00'52'23'E 250.Q0 feet; thence S89.33'31'IIV 966.24 feeit thence S00°52'23"E 420.00 feet; thence S89'33'31'W 528.00 feet; thence S00°52'Z3'E along the North~o~th Quarter Section line of said Section 18 1311.77 feet; thence N89'33'39°E 826,33 feet; thence N00°31'25"W 330.23 feet; thence N89'33'24"E 692.76 feet; thence N00'S2'23'W signg the East iine of the SW +/. ~ the NE '/. 330.31 feet; thence N89°33'24'E along the South Nne of the NE '/. of the NE '/s 94g,Q9 feet; thence N00.52'24'W 1321.19 feet to the Point of Beginning. 'r°> . « ~Y . ~- _. , c~ t~ g~~M 6 U Fr.~2-L.c~U -! 2 or- ~, ~ /J __ ~ ~. P ~1 01 / / o ~ ~33 ~ ~ N / ~ s' 6_ OD N / / / / ,~' / ~ ~, i • / ~ Q N 89 33' J _ I/ ~ 4~ / / ~ 23 / - _ _ ~ ~ LOT 29 70229 S. F. - , ~~ S 89'33'3,1 2 ~ 18 S'~, ~ L1.9.46 T~ ~.~ \ 1.61 Ac. i ~ ~ ~~ \ 16 N 899 46'1 E ~~ ~ ~ / ~ ~0`'~. ~ \ ~ ' / - - 'S ~ ~ \ ~~ ~ ~ ~ -. ~- ,9 ~ ~ LO 24 : ~ ~ , ~ \ \ s~ S.F. ~ ,?~ s \ ~ '~ p ~ 1.60 Ac. Q ~~ 'moo \ ~'• d LOT 22 ~" ~F ~31ao S.F. ~~~ ~~, LOT. 23 ~ ~ 10 ~~~~a \ moo" 68872 S. F\ ~. ,~. ~y 2.14 Ac. \ ~ ~. ~ , r 1.58 Ac. ~~.~ o~ o /\ F / O~ c~<`~` ry"/rya \ F.P = ~ ss~ 110 ~ \ `," 1 OHO ~t \ \ ~^~ / \ ~ LOT 25 / LOT 26 y~ 3 / 3 \ ~~ .N ~ 121064 S. F. ~ 84789 S.F. ~'~ ~h ~ ~; 2.78 Ac. N .95 \ / b _ LBO= 1018' \ / ~ o (n a~N \ h,~ HWE=1014' Z~ \ O 468.25' ~ - ~ ~- 1z2.~s' 127.oa• 366.97' 218.45' SOT 20 D _ ~~~Y~{'~'D~ SOUTH LINE OF THE NE 1 /4-NE 1 /4 ( ~ ~~~~24" W 949.09' ~ D ~~ +~,{~ '~`"~~'~~ R.A. = N 89'54'47" E X9098 S. 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O a ' a ° o ~ QO c ~ m N N N S C A ~ N N N W C N i t ~ p O ~ V1 7 7 fl- i u~io~c~ima~ ~ I 'TJ N ~ C w I W N ~ a ~~ a ~ l Q, N O y ~, O O A O j N ~" ~ ~ O S I mA3vm's ~ '., ~.. ~' m °-~o p~ ~ 01 N p M ~ _a a~ ~ S '~` N N i ~ O O I O ~ 0~~ 69 ~ ti W of ~ ~ y I o ~ ~